What happens in an EMDR therapy session?

person in black pants and black shoes sitting on brown wooden chair

When prospective clients contact me to embark on Eye Movement Desensitisation and Reprocessing (EMDR) therapy, they often ask: 

What’s a typical EMDR treatment session like? 

Below I will illustrate how I usually conduct an EMDR session. Before you read on, it is important to note that I always tailor my approach to the client’s needs, which means that both pace and intensity of each session are adjusted according to the client’s preparedness for therapy, their resilience in facing a wide range of emotions, and their therapeutic goals.

What’s EMDR therapy? 

EMDR is a type of therapy that was created to treat symptoms of Post-Traumatic Stress Disorder (PTSD). According to the theoretical framework behind EMDR, when one experiences psychological trauma, she or he might become stuck in the trauma, that is, the traumatic experience gets frozen in time and it feels like it is consistently repeated in the present. Typical symptoms of PTSD are: flashbacks, nightmares and constant emotional and physiological intrusive memories of the trauma. When PTSD symptoms persevere for more than a month, trauma-focused therapy – such as EMDR – can be extremely helpful in helping the person process the traumatic experience. 

To read a more detailed description of the theory underpinning EMDR therapy, to learn what EMDR therapy can be used for, and to access a number of frequently asked questions on EMDR, click here.

What happens in a typical EMDR therapy session?

EMDR therapy can be divided in three main parts: assessment, preparation and treatment.

Below, I offer a description of each phase, which includes a vignette of a fictional client, Sarah, who suffers from a number of symptoms following psychological trauma. 

In my practice, each session lasts 50 minutes but can be prolonged if the client prefers it. 

Assessment

During this phase, which usually can last one to three sessions, therapist and client meet to discuss the client’s presenting problems, their psychological needs, and her/his history. In EMDR, a strong emphasis is placed on getting to know and understand the client’s personal history, because it often allows the therapist to make sense of the client’s presenting symptoms.

Here’s a vignette of a fictional client’s presentation:
Sarah comes to therapy following a car accident during which she nearly lost her life. The accident happened 2 months ago and Sarah feels that she cannot ‘get over the trauma’ even though she is physically fine. She explains to me that she is easily startled, has nightmares that are symbolically linked to the accident (being chased by something and dying), and becomes easily upset because fragments of the trauma resurface as she gets on with her day (i.e.: the honking sound of the car before the crash). Sarah also has a history of not feeling secure growing up as she had very critical parents and suffered bullying at school. Sarah would like to move on and finally place the traumatic experience where it belongs: in the past. As her therapist, I listen to her concerns attentively and I ask a number of questions, whilst being respectful of her pain and genuinely curious about her current concerns, her traumatic events and her personal history.

As you can read in the vignette above, the task of the EMDR therapist is to sensitively gather information about the client’s symptoms and then start connecting the dots with their personal history to make sense of their present. 

Preparation

EMDR is a very powerful type of therapy that can bring about significant change in periods of time that can be much shorter relative to other traditional talking therapy approaches. During the EMDR session, the processing of emotional content can happen very quickly and sometimes it can feel overwhelming for the client. This is why preparing clients for the treatment is imperative to keep them safe. In this case, the EMDR therapist will help the client ‘install’ emotional resources that can be used in order to make the client more resilient during the processing. Emotional resources are installed by using imagery techniques. This phase could last 1 to 3 sessions, depending on the client’s need. One might argue that this is also part of the actual treatment because it helps clients become more resourceful when they experience their day-to-day unsettling symptoms.

Here is how the preparation phase could look like with Sarah:
After the assessment, I explain to Sarah what EMDR means and how it can be helpful for her. I guide Sarah through some imagery exercises in order enable her to connect with a sense of calm and relaxation. In Sarah’s case, she focuses on a time in her childhood when she had a lovely summer holiday with her best friend and felt happy and content. Sarah and I together make this memory more accessible for her so that she can bring it up when she needs it in the future, both in her daily life and during the EMDR treatment sessions. 

It is often the case that clients need to install a ‘team’ of resources to use during the most difficult times of therapy. It is also important to note that sometimes the installed resources are not needed during the EMDR treatment session, because the processing happens so quickly that the client does not feel emotionally overwhelmed.   

Treatment

After illustrating both the Assessment and the Preparation phase, now it’s time to describe what the actual processing during EMDR looks like.

As it is suggested in the acronym – EMDR – the eye movements are what is traditionally used to help the person process the traumatic material. Typically, the client is asked to follow the therapist’s hand, as the therapist waves it from left to right in front of them – as fast as the client can manage. During the movements, the therapist reminds the client to just notice the material that comes up in their body and mind without judging it. The material can be in the form of thoughts, feelings, body sensations, etc. During the set of eye movements, the client is asked to remain silent if possible. After each set of eye movements, which usually last up to 30 seconds, the client is asked to briefly describe what they noticed and then the movements are resumed. During the movements, the client is also reminded by the therapist that there is no right or wrong material that might come up, because the work is based on free association. 

Ultimately, the therapy aim is to liberate the client from the emotionally negative intensity of their traumatic memories; therefore, it usually happens that the memory becomes less disturbing as the client keeps moving their eyes. 

This phase can last for the amount of sessions needed to process the traumatic memory – typically 6 to 8 sessions. However, sometimes it can much fewer or more sessions.

In the example of Sarah the following might happen:
After Sarah explains what the worst moment of her traumatic experience is, I ask her to focus on some specific elements of the moment. I then begin that hand movements and ask her to track them with her eyes. During the movements, I gently remind Sarah that there is no right or wrong answer and to just notice with curiosity what comes up for her. After each set of movements, I ask Sarah to take a deep breath and then to describe what she has noticed during the movements. Maybe Sarah remembered something else about the experience, or she feels quite tense in her chest, or she feels fearful? I then ask her to continue following my hand. Every now and then I ask Sarah whether the disturbance of the memory has changed in any way. This will inform how I will carry on with the treatment. 

It is noteworthy that – instead of eye movements – self-tapping of shoulders and knees may also be used. This could be a preference of the client or just a practical step to take when, for example, EMDR needs to be conducted online. For further information about how online therapy works, click here.

I hope that the above has shed some light on how a typical EMDR session looks like. If you have any questions, click below to book an initial free 15-minute consultation. 

‘I am grounded in joy; I am not grounded in the trauma anymore’

Tarana Burke

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